Friday, August 19, 2011

Drawn to deliver

I've gotten a lot of questions recently about my push (no pun intended) to become a midwife and its relevance. I think a lot of people who ask me why on earth this is something I would want to do see it through the same scope of scrutiny that the majority of the public in our country does: that a midwife is a glorified nurse, someone who tries to do the job of a doctor with less pay, less education, less experience, and in a more dangerous setting with far more things going wrong. And to a degree, I can't fault them, because that's really all the general public ever hears about midwives. The media throws around all the horror stories, tales of home births gone wrong, of midwives who abuse their position of power over a patient, or of (and this in my opinion is the worst) otherwise fully trained and accredited midwives who try to practice in a state where either their entire profession or their chosen route is somehow illegal and although nothing bad has ever happened, they're turned in for practicing medicine without a license.

When that's all anybody sees or hears, who can blame this country for having such a negative view of midwifery?

The sad thing is, I can't. And believe me, I'm not looking at this from a completely rosy perspective; I understand that things can and do go wrong during otherwise normal birth processes. I understand that no two women or births are alike, and that a woman's supposedly low-risk status isn't a reason to stay on my toes and listen to that voice in the back of my head that wants me to be ready for any possibility. I get that there will be some patients, unfortunately, that I will have to turn away - not because of an inability on my behalf, but because for whatever reason the information they've presented to me or that I've gathered through examining them indicates to me that they might be safer in a more medical setting where the potential care they would need is readily available. I know those things and I've come to accept them, whether or not I want to.

And I know, too, that even the accreditation process carries some inherent risk. I'm a part of a Yahoo group for new and student midwives, and there has been a discussion going on recently about an unfortunate woman who was working as a student (as-of-yet unlicensed) midwife who showed up to a birth before her preceptors (teachers/more or less the women she was apprenticed to). She had everything set up and was ready to go, waiting for them to arrive, but while they were waiting, the baby crowned and showed up a bit faster than anticipated. The parents insisted that despite not having the birth attended by a licensed midwife, that they not transfer (this is where, perhaps, some things were questionable, but without all the details it's hard to know for sure why the parents decided this, and why the student agreed). Afterwards, there seemed to be some pieces of the placenta left over in the mother's uterus, and she was beginning to hemorrhage - so the student, thinking fast, did what was medically necessary to stop the bleeding. Mom and baby were fine. After the fact, a doula at some point discussed the happenings with other midwives, and the student ended up reported to the authorities and was charged with several felonies, including - you guessed it - practicing medicine without a license. Because of this charge, she'll never be able to finish her schooling and become a midwife, and will never be able to hold any state license for any medical field.

Now, working off of core facts, there is a HUGE question here: should the student have continued to honor the parents wishes and acted as she did, or should she have taken a step back and refused to provide any care and called 911? Obviously the choice has already been made, but there are a lot of technicalities here that I think would make this decision difficult for anyone, experienced student or new. It's one of the many problems that I may or may not personally face, and it's impossible for me to say for sure what I would have done (I'd like to think I KNOW what I would have done, but we always say that about ourselves without likely ever finding out the truth). I may face worse problems, bigger problems, along the way. May every god and goddess in every pantheon forbid it, I might well face the death of a client and/or her child. I can't even begin to process that concept, because it's just too "out there" for me, but it is a possibility, however unwelcome and tragic and horrifying.

But it's part of the job. Doctors face the same thing, only they rarely have to worry about consequences from a family because, if they've proven themselves competent and they've done everything they have to to satisfy their insurance and hospital policy, then most of the time, they're off the hook - even if a bunch of medical interference is what might have contributed to the death in the first place.

And it's something that I'll have to accept, something I'm working on accepting even now, when I haven't even been accepted (that's a lot of accepting) into the nursing program at the college I'm at. I'm still taking prerequesets and applying. I'm not even a quarter of the way there yet.

So why, despite all of these horrible things that could or might happen, do I still feel called to become a midwife?

Because I know how beautiful and amazing birth can be. Because my experiences have been not-so-great, because I've learned the trauma of having someone by your side who has pledged to help protect you from the unnecessary who then steps away at the last minute and chooses to be less than supportive. Because I have been bullied into decisions and interventions that I know (thank you, hindsight) were unnecessary or potentially harmful. Because even after making up my mind and setting my jaw and telling my OB what I would or would not allow, I was still told that in the long run my wishes were secondary to hospital policy, or "what was allowed". Because I know that my experiences and the experiences of so many other women who are now completely jaded to the birthing process do not have to be the experiences of EVERY woman. Because I know birth can be better, happier, more relaxed, and can be allowed to progress on its own without inherently risking the safety of anyone involved. Because I know and believe that women and babies deserve better, and should have better, but that it will take an entirely new generation of midwives who are able and ready to fight the system of heavily medicalized births that have become so common in so many areas.

Because I can, and I want to, and I think it's right.

Isn't that the biggest reason that anybody does anything they believe in?